Thursday, January 22, 2015

APPE Pharmacy Rotation #4: Neonatal Intensive Care Unit (NICU) and Pediatrics



My 4th rotation (4 of 6) was at Advocate Illinois Masonic Medical Center (AIMMC) and it went from late November to early January. I introduced this rotation to you briefly in my 7 Quick Takes #44 post. 

It was a tough rotation for two reasons:

1) It was a completely new and unknown area of medicine / pharmacy for me (neonatal medications and doses are completely different and there is a general lack of studies in neonates so medications are often used off-label, without concrete evidence from clinical trials; thus in a lot of cases we have to use our personal/clinical judgement)
2) The hospital is 37 miles away from my house and required a drive not only into Chicago but across Chicago's downtown and all the way into the North side of the city. In order not to spend 2 hours driving one direction, I had to leave my house at 5am, and also stay at the site until 6pm. In the mornings it took ~ 1 hour to get there and in the evening about 1h 20 minutes (if I left anytime between 2pm and 6pm...forget it...it was 2 hours on the dot...thus I stayed after a lot and worked on projects).

And so while my days were very long, they flew by so fast! And despite the long days and long commutes, this was probably my favorite rotation so far!


[[This is why it's important to have pharmacists in the NICU]]

In a nutshell, this was my daily routine on this rotation:
  • 6am --> Free time (b/c I got there super early) which I used for projects, reading, and residency applications
  • 7:30am --> Study charts of newborns in the NICU (paid particular attention to medications, doses, and lab values; noted anything that was off/ questionable/ abnormal)
  • 9am --> Interdisciplinary Rounds in the NICU (consisted of 3 neonatologists, Pharmacist, Pharmacy Resident, Pharmacy Student (me), Head Nurse, Dietician, Social Worker)
  • 10am --> Look through charts of children on the pediatric floor
  • 10:30am --> Pediatric Interdisciplinary Rounds (Pediatrician, Pharmacy Team, Nurses, Social Workers, Child Life Specialist)
  • 11am --> Back to my "office" aka the pharmacists' conference room; free to work on that day's topic discussions that were assigned to me by my preceptor and on projects (while my pharmacist/preceptor was mostly busy checking med orders and answering phone calls from doctors/nurses)
  • 12pm --> Lunch
  • 12:30pm --> Either project time or topic discussions with my pharmacist preceptor and/or resident
  • 2:10pm --> " Change of Shift" pharmacy meeting inside the central pharmacy
  • 2:30pm --> Presented my projects, or worked on my projects, or discussed various disease states ("topic discussion") or medications with my preceptor. Went back up to the NICU if anything else had to be done (ex: TPN ["total parenteral nutrition"] orders).
  • 4:30pm --> Free to go home but I stayed due to traffic and continued to work on residency applications and sometimes blog posts

This is the conference room that they let me use as my work space aka "office." This is also where they held pharmacist meetings and where I presented my projects.


Pictures from my daily commute through downtown Chicago

This was the only day where I saw daylight (and MY MISTAKE, I was stuck in traffic forever).
The rest of the 6 weeks, I left home when it was dark and left the hospital when it was dark.


The things that made me feel alive and joyful and excited on this rotation:
The daily assigned readings and topic discussions (which stemmed from real patient cases we encountered on those particular days) were super interesting to me. Reading pages of pages of material about pregnancy, fetal development, neonatal complications, the medical needs of premature babies DIDN'T even feel like work. I enjoyed it so very much because it allowed me to learn a lot about pregnancy and taking care of newborn infants, especially premature newborns....and to me that was amazing and beneficial not only for my professional life but I took it to heart as a future mother (God willing). Truly, the future mother in me woke up. As I encountered these very premature neonates daily and as I read about their diseases/complications/risks I became very concerned. I paid close attention to all the articles I read in medical journals because I knew that I wasn't just reading this stuff to complete an assignment or to get an A on this rotation...but that this knowledge IS FOR ME, personally.

And just seeing the babies every day was in itself amazing. Each and every one of them was a little miracle from God. I mean, my Lord, some of them were born at 23, 24, and 25 weeks and they did such a great job fighting for their life! 

Oh how happy the babies made me!

As evidence, here's a note that I wrote down on the exact day of my 1st rounds in the NICU:


11/18/14 
Today was my first real day in the NICU. Today I saw the babies. <3 <3 <3 <3. So tiny. So fragile. So quiet. So cute. My heart was melting as I walked from incubator to incubator. All preemies in the NICU. I read notes about them in the AM as I prepared for rounds. I read about one of them being 27 weeks. About another weighing only 0.6kg. But I didn't realize how tiny (almost unreal) they were until I saw them. Never seen such tiny babies before. They were all so calm...just sleeping so peacefully. They looked comfortable. I wanted to cuddle each one of them.

I mean this rotation made me so happy that I caught myself just singing both in my car and while walking to the hospital every morning before 6am....I just noticed that throughout this rotation I just kept smiling to myself like an idiot, and singing to myself, and just praying and thanking God for every single day. I am so glad my other rotation was cancelled and God put me here instead - I could definitely see His Will in this. 

I saw a lot of faith in the parents' of the little NICU babies that were fighting for their lives. I saw pictures of the Guardian Angel, of the Virgin of Guadalupe, and even a picture of Jesus of Divine Mercy with the "Jesus I trust in You" emblem (which I thought was awesome...since I am very close to this imagine because St. Faustina, who it was revealed to, is from my home country of Poland and I read her famous diary, which changed me and my life in a lot of ways.) And when I saw those pictures neatly taped to the little preemies' incubators, it reminded me to pray for them also, and so I did. I guess I was there also for reasons other than just simply to be a pharmacy student :-)

And some of the others things that made me happy:
1) the views from the 7th floor medical library
a) on a nice day

b) on a snowy day

And this little nook I found in the library of the hospital, away from everyone, and with a gorgeous view (pictured above). Perfect for my little nerdy, introverted self :-) Perfect to hide from the world and READ medical literature blogs.

The things that made me feel really sad on this rotation:
What depressed me is seeing a baby born very prematurely and struggle and fight for his life...because the mother had a history of drug abuse DURING pregnancy and tested positive for 4 different illicit substances even DURING her delivery. Come on now. You almost killed your baby for very selfish and foolish reasons.

Seeing a baby being re-intubated for the 2nd or 3rd time because they were just not willing to breathe on their own.

Seeing a special nurse place a huge IV needle into this little 25 week old baby's teeny tiny fragile leg (its leg was literally the size of my index finger).

And reading chart after chart after chart and seeing how many women had histories of MULTIPLE abortions. It almost seemed like I saw EAB ("elective abortion") on almost everyone's file. It was unbelievable and dreadful to me to scroll through those patient histories. And I almost started to wonder if these babies that are being born either prematurely or with complications, whether that has anything to do with these women's "choices" to undergo these elective abortion procedures, which are known to be very hard on the woman's body and can often make one infertile or unable to carry another baby to full term. It saddened me deeply to see young women make choices such as doing drugs and killing the babies in their womb, electively, selfishly, for convenience.


And some of the projects I worked on...
I had to do a patient case presentation, a drug information paper, and a journal club.





The powerpoint I made for my Patient Case Presentation, which was on pediatric meningitis.


AND FINALLY, I took some pictures on my iPad in the conference room (I had a lot of project time to myself, haha) and I noticed just how tired I looked by the end of it all, haha. (But I would not have traded this rotation for another one, it was really really great).

PHARMACY ROTATION: 1ST WEEK VS LAST WEEK.




PHARMACY STUDENT
ON CLINICAL SPECIALTY ROTATION
WEEK 1
PHARMACY STUDENT
ON CLINICAL SPECIALTY ROTATION
WEEK 2

PHARMACY STUDENT
ON CLINICAL SPECIALTY ROTATION
WEEK 6



And that is all.
Overall, I absolutely loved my NICU/Peds rotation and I know and I know and I know that GOD put me there for a reason!




Sincerely, 
Agnes

8 comments:

  1. This is wonderful. I know it was a long rotation for you, but I am glad it was such a good experience. We just had our new neighbor over for dinner last night. She is a pharmacist with a transplant team and it was really interesting hearing about her job. Keep up the good work.

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  2. This mom of a 29.5 weeker thanks you for your work in the NICU. Daniel spent two months there and we've also had stays in the PICU and peds ward a few times with RSV. Before I had Daniel, I didn't know of practices like caffeine being given to promote lung development or surfactant to get the lungs open after birth.

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    1. You're right...I didn't know about things like caffeine and surfactant much either, until I got to the NICU. We had babies in the NICU that were going to be there for 4+ months...I couldn't even begin to imagine what the parents were going through...it was good that I had this experience, because, who knows, perhaps God will bless me with a personal experience like this with my own baby someday.

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    2. It's definitely not a place that most people are called to serve, which makes those who choose to do so into some really special people.

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  3. Beautiful! Thank you for sharing! May God continue to bless you

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  4. What a beautiful reflection. I love hearing your stories.

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    Replies
    1. Thank you Ellen. I'm glad you like 'em :-)

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